The Danish Ventral Hernia Database, Copenhagen, Denmark.
J Am Coll Surg. 2013 Feb;216(2):217-28. doi: 10.1016/j.jamcollsurg.2012.10.013. Epub 2012 Dec 7.
Incisional hernia repair is a frequent surgical procedure, but perioperative risk factors and outcomes have not been prospectively assessed in large-scale studies. The aim of this nationwide study was to analyze surgical risk factors for early and late outcomes after incisional hernia repair.
We conducted a prospective nationwide study on all elective incisional hernia repairs registered in the Danish Ventral Hernia Database between January 1, 2007 and December 31, 2010. Main outcomes measures were surgical risk factors for 30-day readmission, reoperation (excluding recurrence), and mortality after incisional hernia repair. Late outcomes included reoperation for recurrence during the follow-up period. Follow-up was obtained by merging the Danish Ventral Hernia Database with the Danish National Patient Register. Results were evaluated by multivariate analyses.
The study included 3,258 incisional hernia repairs. Median follow-up was 21 months (interquartile range 10 to 35 months). The 30-day readmission, reoperation, and mortality rates were 13.3%, 2.2%, and 0.5%, respectively. Advanced age, open repair, large hernia defect, and vertical incision at the primary laparotomy were significant independent risk factors for poor early outcomes (p < 0.05). The cumulated risk of recurrence repair after open and laparoscopic repair was 21.1% and 15.5%, respectively (p = 0.03). Younger age, open repair, hernia defects >7 cm, and onlay or intraperitoneal mesh positioning in open repair were significant risk factors for poor late outcomes (p < 0.05).
Elective incisional hernia repair were beset with high rates of readmission and reoperation for recurrence. Readmission and reoperation for recurrence were most pronounced after open repair and repair for hernia defects up to 20 cm. Additionally, sublay mesh position reduced the risk of reoperation for recurrence after open repairs.
切口疝修补术是一种常见的手术，但在大规模研究中尚未前瞻性评估围手术期的风险因素和结果。本项全国性研究旨在分析切口疝修补术后早期和晚期结果的手术相关风险因素。
我们对 2007 年 1 月 1 日至 2010 年 12 月 31 日期间在丹麦腹疝数据库中登记的所有择期切口疝修补术进行了前瞻性全国性研究。主要观察指标为 30 天再入院、再次手术（不包括复发）和切口疝修补术后死亡的手术相关风险因素。晚期结果包括随访期间因复发而再次手术。通过将丹麦腹疝数据库与丹麦国家患者登记处合并，获得随访结果。通过多变量分析评估结果。
本研究纳入了 3258 例切口疝修补术。中位随访时间为 21 个月（四分位距 10 至 35 个月）。30 天再入院、再次手术和死亡率分别为 13.3%、2.2%和 0.5%。高龄、开放式修补、巨大疝缺损和初次剖腹术时的垂直切口是早期不良结局的显著独立危险因素（p < 0.05）。开放式和腹腔镜修补术后复发的累积再手术风险分别为 21.1%和 15.5%（p = 0.03）。年龄较小、开放式修补、疝缺损 >7cm 以及开放式修补时的网片置于补片下或腹腔内是晚期不良结局的显著危险因素（p < 0.05）。
择期切口疝修补术再入院和复发再手术的发生率较高。开放式修补术和疝缺损最大至 20cm 的修补术，复发再手术的发生率最高。此外，开放式修补术后，网片置于补片下可降低复发再手术的风险。
